1025896 - Prioritizing local needs and culture when developing rehabilitation training materials for use in another country.

Objective :

Identify key training needs and cultural considerations to guide development of video-based training on adaptive feeding strategies for use by community-based rehabilitation (CBR) workers and caregivers of children with cerebral palsy (CP) in West Bengal, India.

Design : Quantitative and qualitative data were collected from three sources: focus groups with CBR workers, focus groups with caregivers of children with CP, and in-home observations of mealtime by occupational therapists.

Setting : Home-based and community settings

Participants (or Animals, Specimens, Cadavers) : Seven 2-hour focus groups were conducted with a total of 19 CBR workers and 34 caregivers. In addition, 13 families consented to a 1-hour in-home feeding observation involving a child with CP. Participants were recruited from rural, suburban and urban regions of West Bengal

Interventions :

Not applicable

Main Outcome Measure(s) : Focus groups were used to identify mealtime-related difficulties. In-home observations used an adapted version of the modified Functional Feeding Assessment

Results : Caregivers and CBR workers reported two primary feeding difficulties: (a) managing the child's posture, and (b) managing the child's oral-motor impairments that affect chewing food, swallowing and oral hygiene. The in-home OT observations supported these findings and identified two additional concerns related to use of water to initiate swallowing and use of mixed food texture. Across all three data collection methods, four important cultural considerations became apparent: use of Bengali as a locally spoken language, common practice of floor sitting during mealtime, use of hand instead of spoon or fork, and use of rice and vegetables in a mashed form.

Conclusions : The findings underscore the necessity of conducting a multi-faceted, culturally-sensitive needs assessment when developing rehabilitation training materials for use in other countries.